RESEARCH ARTICLE

Sweet/Dessert Foods Are More Appealing to

Adolescents after Sleep Restriction
Stacey L. Simon1*, Julie Field2, Lauren E. Miller3, Mark DiFrancesco2, Dean W. Beebe2,4
1 Children’s Hospital Colorado & University of Colorado School of Medicine, Aurora, CO, United States of
America, 2 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America, 3
Department of Psychology, University of Connecticut, Storrs, CT, United States of America, 4 Department of
Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America

* stacey.simon@childrenscolorado.org

Abstract

Study Objective
Examine the effect of experimental sleep restriction (SR) on adolescents’ subjective hunger
and perceived appeal of sweet/dessert foods versus other foods. A secondary goal was to
replicate previous findings on the effects of SR on dietary intake.
OPEN ACCESS

Citation: Simon SL, Field J, Miller LE, DiFrancesco

Design
M, Beebe DW (2015) Sweet/Dessert Foods Are More Randomized cross-over sleep restriction-extension paradigm.
Appealing to Adolescents after Sleep Restriction.
PLoS ONE 10(2): e0115434. doi:10.1371/journal.
Setting
pone.0115434
Sleep was obtained and monitored at home. Outcome measures were gathered during
Academic Editor: Ralph E Mistlberger, Simon
Fraser University, CANADA office visits.

Received: April 18, 2014

Participants
Accepted: September 29, 2014
31 typically-developing adolescents aged 14–17 years.
Published: February 23, 2015

Copyright: © 2015 Simon et al. This is an open Interventions

access article distributed under the terms of the The three-week protocol consisted of a baseline week, followed randomly by five consecu-
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
tive nights of SR (6.5 hours in bed) versus healthy sleep duration (HS; 10 hours in bed), a 2-
medium, provided the original author and source are night wash-out period, and a 5-night cross-over.
credited.

Data Availability Statement: All relevant data are Measurements

within the paper and its Supporting Information files. Sleep was monitored via actigraphy. The morning after each experimental condition, teens
Funding: This work was supported by the National rated their hunger, underwent a 24-hour diet recall interview, and rated the appeal of a se-
Institutes of Health (R01 HL092149, UL1 RR026314). ries of pictures of sweet/dessert foods (e.g., ice cream, candy) and non-sweets (meat,
The funders had no role in study design, data
eggs, fruits, vegetables).
collection and analysis, decision to publish, or
preparation of the manuscript.

Competing Interests: The authors have declared

that no competing interests exist.

PLOS ONE | DOI:10.1371/journal.pone.0115434 February 23, 2015 1/8

 Adolescent Sleep Restriction and Food Perceptions

Results
Teens rated pictures of sweet/dessert foods to be more appealing after SR than after HS
(Cohen’s d = .41, t = 2.07, p = .045). The sleep manipulation did not affect self-reported hun-
ger or the appeal of non-sweet foods (p >.10). Consistent with our prior work, intake of over-
all calories was 11% higher and consumption of sweet/dessert servings was 52% greater
during SR than HS.

Conclusions
Adolescent SR appears to increase the subjective appeal of sweet/dessert foods, indicating
a potential mechanism by which SR might contribute to weight gain and the risk for obesity
and chronic illness.

Introduction
Short sleep correlates with both concurrent and future obesity, leading to speculation that inad-
equate sleep may contribute to the obesity crisis [1,2]. Indeed, experimentally-induced acute
sleep deprivation increases adults’ caloric intake beyond the increased energy required to main-
tain wakefulness [3,4]. We recently reported similar findings in adolescents (see S1 PDF), who
ate significantly more foods high in simple sugars, especially sweets and desserts, when sleep-
restricted (SR) than when well-rested [5]. While studying this phenomenon is important in
any age range, we consider it particularly important during adolescence because this develop-
mental period is uniquely characterized by increased exposure to SR [6] at the same time that
individuals’ dietary choices become more independent and form the foundation for enduring
dietary patterns [7].
Additional work is needed to replicate our findings and to explicate the mechanism by
which SR might affect adolescents’ dietary behaviors. One potential mechanism is a shift in he-
donic value. Using behavioral economics theory, if SR causes teens to perceive sweet-tasting
foods as more appealing, the intake of those foods would be expected to increase [8]. Sleep-de-
prived adults experience an increase in subjective cravings for calorie-dense foods.[9] However,
it is difficult to generalize adult findings to adolescents because of developmental differences in
sleep and dietary needs.
Here we report on a follow-up study in which we examined changes in subjective hunger
and perceived appeal of sweets/desserts and non-sweet food in a new sample of adolescents
after 5 nights of experimental SR versus healthy-sleep duration (HS). We hypothesized that
teens would report greater hunger and rate sweets/desserts, but not non-sweets, as more ap-
pealing after SR than after HS. Finally, we explored whether the effect sizes for intake of overall
calories and sweets/desserts in the current sample were similar to those in our previous study.

Methods
Ethics Statement
All procedures were approved by the Institutional Review Board at Cincinnati Children’s Hos-
pital Medical Center. All participants and their parents provided written documentation of in-
formed assent and consent following receipt of print and verbal information regarding
the study.

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 Adolescent Sleep Restriction and Food Perceptions

Participants
Participants were recruited from flyers posted throughout a regional care network and, to help
ensure representation of underserved populations, research staff were available to answer ques-
tions in an adolescent health clinic that tends to serve low-income families. Interested adoles-
cents and their parent were contacted via phone for formal screening. Similar to our prior
study [5], we enrolled typically-developing 14–17 year-olds without a current psychiatric diag-
nosis or history of neurological illness/injury. In addition, we excluded for intellectual disability
or marked obesity (IQ<70 or BMI>30, initially screened by parent and teen report, then con-
firmed objectively during a baseline visit).

Sleep Manipulation and Assessment

The 3-week sleep protocol was identical to the prior study (Fig. 1). Teens’ circadian phase was
first stabilized in a baseline week, during which they could self-select their bedtimes, but were
asked to consistently awaken at a time that would allow them to come in to our office for an
8:30 AM appointment/visit. That wake time was maintained throughout the study (i.e., subjects
were not allowed to “sleep in” any morning during the study, including the weekends) to mini-
mize shifts in circadian rhythm. Adolescents who successfully completed the baseline week
were randomized to an order of the experimental conditions (SR first vs. HS first) in a

Fig 1. Schematic Diagram of Sleep Protocol. Rise-time for all weeks was determined by when teens
needed to awaken to arrive at the study location by 8:30am. Teens self-selected bedtime during the baseline
week and Saturday/Sunday nights between conditions. During the experimental weeks, bedtimes Monday-
Friday were altered to allow sleep opportunity of 6.5-hours (SR) versus 10-hours (HS).
doi:10.1371/journal.pone.0115434.g001

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 Adolescent Sleep Restriction and Food Perceptions

counterbalanced, within-subjects crossover design. When in the SR condition, teens’ bedtimes

were adjusted to allow 6.5 hours in bed each night for 5 nights. When in the HS condition,
their bedtimes were set to allow 10 hours in bed each night for 5 nights. The conditions were
separated by a 2-night washout with the same sleep instructions as the baseline. Teens were
asked to refrain from napping and limit caffeine intake to no more than 1 coffee or energy
drink per day or no more than 2 caffeinated sodas per day.
All sleep occurred at home and was monitored via a daily sleep diary and actigraphy
(MicroMotionlogger Sleep Watch, Ambulatory Monitoring, Inc.). Assessments were con-
ducted on Saturday mornings after each experimental condition. Actigraphy data were up-
loaded and reviewed with both teen and parent during each visit to verify accuracy. Artifact-
free actigraphy data were run though a validated algorithm [10] to determine each teen’s aver-
age sleep duration within each sleep condition.

Outcome Measures
The primary outcomes for this study were obtained via a computerized food-appeal rating-
system. Two matched sets with 84 photos of 42 sweets/desserts and 42 non-sweets (fruits/
vegetables, meat/eggs) were compiled. One set was viewed at each experimental week visit
and teens were asked to rate how appetizing each picture looked on a 1–4 scale (“gross,”
“OK,” “good,” “delicious”). Internal consistency of ratings was strong (sweets α = .90-.92, non-
sweets α = .86-.91). Each teen’s mean rating was computed for each food type (sweets, non-
sweets) within each condition (SR and HS), yielding composites with high test-retest reliability
(r = .79-.83). Teens rated their hunger on a 4-point scale from “not hungry” to “very hungry”
immediately after the food-appeal ratings.
To allow for exploratory comparison against our prior dietary findings, roughly 3/4 of the
sample also underwent a 24-hour diet recall at each experimental week assessment visit using
the USDA Multiple Pass Method [11]. Missing data were due to unavailability of trained inter-
viewers at the beginning of data collection. All dietary interviews were conducted between 8:30
and 11:30 am, with the interviews staggered such that any given teen was interviewed at the
same time of day across both experimental conditions. There was no apparent relationship be-
tween time of the interview and our dietary outcomes, probably because all interviews were
conducted during a narrow time window, and asked about dietary intake the previous day (i.e.,
interviews conducted Saturday morning asked about food intake Friday). Using previously-de-
scribed methods [5], total caloric intake and number of servings of sweets/desserts consumed
during each assessed 24-hour period were calculated.

Statistical Analyses
For the food appeal analyses, subjects who indicated a strong dislike (mean rating <2) of a par-
ticular food type were removed from that analysis. For all outcome variables, potential carry-
over effects of the sleep manipulation were explored via general linear modeling, entering as
predictors the sleep condition, order in which the sleep conditions were presented, and the
order X condition interaction. A significant interaction would indicate a carryover effect. No
significant interaction was found across any of our outcome measures (all p > .05), indicating
that the effect of sleep manipulation did not vary based on the order in which HS or SR was
presented. This allowed us to simplify analyses to paired sample t-tests that examined the ef-
fects of sleep manipulation on food appeal and hunger ratings, as well as on sweet/dessert and
caloric intake.

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 Adolescent Sleep Restriction and Food Perceptions

Results
Sample
Of 38 teens randomized to the sleep manipulation, one dropped out and 6 were non-adherent
to the sleep protocol (defined as <60 minutes difference in average sleep duration across the
SR and HS conditions), leaving a final sample of 31 (59% female, 52% Caucasian, 41% African-
American, mean age 15.7 ± 1.0 years). Actigraphs malfunctioned for 3 subjects, whose adher-
ence to the sleep regimen was confirmed by parent report. The nightly sleep for the other 28
was markedly shorter during SR (6.7 ± 0.6 hr) than HS (9.1 ± 0.7 hr) (p<.0001). As planned,
this difference in sleep duration was due to later sleep onset during SR (after midnight: 0:34 ± 0:45)
than HS (22:06 ± 0:57) (p<.0001), in the presence of highly similar wake times across conditions
(SR: 7:12 ± 0:25 vs. HS: 7:11 ± 0:33) (p > .70).

Food Appeal and Hunger

Fig. 2 summarizes effects of the sleep manipulation on food appeal and hunger ratings. Images
of sweets/desserts were rated more appealing after SR than HS (t = 2.07, p = .049), but the effect
of sleep manipulation was non-significant for self-reported hunger and the appeal of non-
sweet foods (p >.10). In exploratory analyses, results were similarly non-significant when the
non-sweets were split into meats/eggs versus fruits/vegetables.

Sweet/Dessert Foods and Calorie Consumption

In our prior work, after removing outliers who consumed >4000 calories/day, SR increased ca-
loric intake by 9% and intake of sweets/desserts by 130%. Using the same criteria, the 23 teens
in this study with dietary data ate 11% more calories (kcal) during SR (1860 ± 689 kcal) than
HS (1647 ± 508 kcal) and 52% more servings of sweets/desserts during SR (0.74 ± 1.49 serv-
ings) than HS (0.49 ± 0.76 servings). Larger effects were observed without removing caloric
outliers (SR increased caloric intake by 23% and intake of sweets/desserts by 73%), but it is
difficult to compare these findings to our previous publication due to cross-sample differences
in selection criteria. Applying our previously-published selection criteria to pool data from
both studies (n = 68), teens consumed 10% more calories in a 24-hour period during SR
(1934 ± 740 kcal) than HS (1764 ± 649 kcal), d = .25, t = 2.1 (p = .039), and 110% more servings

Fig 2. Effect of Sleep Restriction on Adolescents’ Ratings of Hunger and the Appeal of Sweet/Dessert
Foods and Non-Sweet Foods (meats, eggs, fruits, vegetables). To promote comparison across outcome
measures, effects are expressed as the standardized Cohen’s d. Cohen’s d represents the average of
subjects’ differences in ratings across the two experimental sleep conditions, divided by the standard
deviation of those differences. By convention, d = .20 indicates a small effect and d = .50 indicates a medium-
sized effect [21]. Positive values indicate higher ratings in the Sleep Restriction (SR) condition than in the
Healthy Sleep Duration (HS) condition.
doi:10.1371/journal.pone.0115434.g002

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 Adolescent Sleep Restriction and Food Perceptions

of sweets/desserts during SR (1.46 ± 2.11 servings) than HS (0.75 ± 1.13 servings), d = .30,
t = 2.4 (p = .017).

Discussion
This study builds upon our prior work in three ways. First, it substantively replicated in a new
sample our prior finding that SR increases the caloric intake of teens. Second, it provided more
evidence for the unique impact of SR on adolescents’ perceptions and intake of foods that are
generally regarded as sweets or desserts, such as ice cream, cake, and candy. Finally, it took an
important step in the construction of a mechanistic causal model by which SR might influence
dietary choices, suggesting that SR may increase the subjective appeal of already attractive
sweet/dessert foods.
To our knowledge, this study is the first to investigate food-appeal in sleep-restricted adoles-
cents. In adults, SR particularly increases intake of carbohydrates and fat [12,13], and cravings
for calorie-dense foods [9], suggesting sleep deprivation makes these foods more rewarding.
Consistent with this, adult functional neuroimaging studies show that pictures of appealing
foods trigger a greater response in reward-relevant brain regions after SR than after a period of
full rest [14]. These reward-relevant brain regions also are abnormally responsive to high-calo-
rie foods among people with obesity [15]. Beyond promoting obesity, a diet of high-sugar
foods has been independently linked to several chronic health conditions (e.g., metabolic syn-
drome, diabetes, heart disease) [16].
The proposed shift in hedonic value of sweets/desserts does not exclude other mechanisms
by which SR might impact diet (e.g., circadian factors, disinhibition), an area ripe for additional
work. We recommend future research also overcome several limitations of this study, including
our limited outcome measures, measurement exclusively after 5 nights of SR (as opposed to ex-
amining change as sleep debt accumulates), small sample, and lack of assessment of partici-
pants’ activity level. Additionally, our study did not take into account female menstrual cycle;
while sleep timing and composition show relatively little fluctuation across the menstrual cycle
in healthy women [17], increases in caloric and macronutrient intake have been found during
the midluteal phase [18]. Our study also used a relatively short “washout” period (2 days),
though it is reassuring to note that we found no evidence of carryover effects across conditions,
and similar experimental work has found that 2 days is sufficient to eliminate the effects of par-
tial sleep restriction on dietary intake in adults [19]. Importantly, our use of a randomized
cross-over design helped ensure that neither menstrual cycle nor length of washout would con-
found results, though both could affect error variance. Lastly, more sensitive measurements of
hunger integrating both subjective and physiological measures would be helpful.
If future research corroborates present findings, the potential public health impact could be
impressive. As biological and social factors push bedtimes later, teens’ schools start earlier,
leading them to average 2-hours less sleep on school nights than recommended [6]. Because
adolescents establish enduring dietary patterns [7], and because adolescent obesity is highly
persistent [20], the effects of SR could have life-long consequences, even if short sleep is limited
to the high school years.

Supporting Information
S1 PDF. Beebe DW, Simon S, Summer S, Hemmer S, Strotman D, et al. (2013). Dietary in-
take following experimentally restricted sleep in adolescents. Sleep 36: 827–834.
(PDF)

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 Adolescent Sleep Restriction and Food Perceptions

S1 File. De-Identified Dataset.

(ZIP)
S2 File. Analyses Syntax.
(ZIP)

Author Contributions
Conceived and designed the experiments: DWB MD. Performed the experiments: DWB JF
LEM SLS. Analyzed the data: DWB. Contributed reagents/materials/analysis tools: DWB.
Wrote the paper: SLS DWB. Critical review of manuscript: JF LEM MD.

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